Hope Manor Residential Home

Hope Manor Residential Home is a residential care home located in Salford, Greater Manchester, owned and operated by Coveleaf Limited. The home provides personal care and support for up to 26 people. Some people are living with dementia.

The home is a large, extended detached building with an enclosed outside space and garden area. There are two floors, accessible by a lift and stairs. Each floor provides a variety of personal bedrooms and communal areas to meet the different needs and preferences of individuals. At the time of the inspection there were 25 people living at the home.

People’s experience of using this service and what we found

People and their relatives told us staff were kind, caring and respectful. We observed warm and friendly interactions from staff with people and their visitors. All the people we spoke with told us they felt safe living at Hope Manor Residential Home. Relatives were similarly positive about the safe care and treatment provided to their loved ones. People received their medicines as prescribed and were supported to maintain good health and access healthcare services. Advice and support was sought from healthcare professionals where risks to people’s health and well-being had been identified.

A good standard of accommodation was provided. The home was clean with appropriate infection control processes in place. A team of housekeepers were employed, with oversight from a head housekeeper. Cleaning schedules were in place to ensure bedroom, bathrooms and communal areas were cleaned regularly.

Suitable aids and adaptations were available to aid people's mobility and promote their safety. People received their medicines as prescribed. Servicing and maintenance checks were carried out to ensure the premises and equipment were kept safe. Works had been completed to ensure the building remained compliant with regards to fire safety. Effective systems were in place for the recording and reporting of any safeguarding concerns and complaints. A complaint had been dealt with appropriately, and as per company processes.

Staff were deployed to support people effectively and people living at the home told us they were happy with the number of staff on shift; any requests for assistance were met quickly. Safe recruitment processes were in place. A range of training and development opportunities were provided to support staff. Staff said they were supported in their role and the team worked well together.

People enjoyed a positive mealtime experience. Independence was promoted by staff and people were encouraged to eat and drink enough to maintain a balanced diet.

Management systems were robust and provided clear monitoring and oversight of the service. Plans were in place to help identify areas of continuous improvement and learning.

People were involved in the assessment and planning of their care and support. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for the service was Good, published on 18 July 2017.

Why we inspected

This inspection was prompted by a review of the information we held about this service.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

We found the following examples of good practice:

On arrival to the home, proof of a negative lateral flow test (LFT) was required and personal protective equipment (PPE) needed to be worn. We spoke with the registered manager to ensure there was more prominent signage in the reception area regarding infection prevention control (IPC) procedures. For example, regarding good hand hygiene practices and the importance of wearing personal protective equipment (PPE).

Social distancing was encouraged where possible, such as ensuring there was enough space between seating in lounges and communal areas.

Zoning arrangements were used if people needed to self-isolate in certain areas of the home, such as bedrooms. Testing arrangements were in place for both staff and people using the service and were followed. One person sometimes refused to complete a test and we asked the registered manager to implement a risk assessment to show how this was being managed.

All staff working at the home had received their COVID-19 vaccination. Some staff had left employment on 13 November 2021 when the requirement first came into force due to not wanting to receive the vaccine.

Appropriate arrangements were in place for new admissions, such as requesting confirmation of a negative test and self-isolating if required.

Enough PPE was available and we saw staff wore it at all times during our visit.

We observed the home to be clean and tidy, with domestic staff carrying out their duties throughout the day. Windows were opened at various times during the day to assist with ventilation and outdoor facilities were used when better weather allowed.

There were enough staff to care for people safely, with staff receiving additional infection control training during the pandemic, although some of this needed to be updated. Agency staff were used to fill any gaps in rotas where regular staff were unavailable.

Risk assessments were in place where certain groups may be at higher risk of contracting the virus, although we asked the registered manager to complete a risk assessment for one member of staff who had recently started working at the home.

An appropriate infection control procedure was in place, with specific reference to Covid-19 and regular infection control audits were undertaken to ensure standards were maintained.

Further information is in the detailed findings below.

Hope Manor is a residential care home located in Salford, Greater Manchester and is owned and operated by Coveleaf Limited. Hope Manor is an older building with accommodation set over two floors. The home is situated off a busy main road and close to local amenities. Parking facilities are available at the front of the home which also facilitates wheel chair access. Hope Manor is registered with the Care Quality Commission (CQC) to provide personal care and accommodation for up to 26 people. At the time of our inspection there were 23 people living at the home.

The home was last inspected on 23 and 24 March 2016, when we rated the service as ‘requires improvement’ overall and identified two breaches of the regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These were in relation to person-centred care and staffing.

At this inspection we found the service had made improvements and was now meeting all regulatory requirements. We did not identify any current concerns with the care provided to people living at the home.

At the time of the inspection the home had a registered manager. ‘A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.’

We found the home to be clean with appropriate infection control processes in place. Three housekeepers were employed and worked on a rota system to ensure daily input was provided. We saw detailed cleaning schedules in place to ensure bedroom, bathrooms and communal areas were cleaned regularly.

All the people we spoke with told us they felt safe and loved living at Hope Manor. Relatives were similarly positive about the safe care and treatment provided to their loved ones. The home had appropriate safeguarding policies and procedures in place, along with instructions on how to report safeguarding concerns to the local authority. All staff had been trained in safeguarding adults and knew how to identify and report any safeguarding or whistleblowing concerns.

Staffing was organised based on people’s dependency levels, with assessments of need being completed every month. We saw enough staff had been deployed to support people effectively and people living at the home told us they were happy with the number of staff on shift and any requests for assistance were met quickly.

Both the registered manager and staff we spoke with demonstrated a good knowledge and understanding of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS), which are used when someone needs to be deprived of their liberty in their best interest. We saw the service was working within the principles of the MCA and had followed the correct procedures when making DoLS applications. The home had implemented DoLS care plans to ensure any recommendations or conditions listed on the DoLS authorisations had been addressed.

We saw medicines were stored, handled and administered safely and effectively. All necessary documentation was in place and was completed consistently. Staff responsible for administering medicines were trained and had their competency assessed annually. The home completed daily, weekly and monthly medicines audits, to ensure administration and recording had been completed accurately.

Staff spoke positively about the training available and we saw the home had links with the local college. All staff completed an induction upon commencing employment, which included a flexible period of shadowing experienced staff. We saw staff had been enrolled on the care certificate and on-going training was provided to ensure skills and knowledge remained to date.

Staff told us they received regular supervision, which along with the completion of monthly team meetings, ensured they were supported in their roles.

Meal times were observed to be a positive experience, with people able to choose where they sat and what they ate. Meal options were provided at point of service, with additional options being readily available for those who did not like what was on offer. Staff supporting meal times were attentive, ensuring people had drinks, were served promptly and dishes cleared after eating. The home had monitoring charts in place to record people’s food and fluid intake, with nutritional care plans in place for those with special dietary requirements.

Throughout the inspection we observed positive and appropriate interactions between staff and people living at the home. Staff were kind, caring and treated people with dignity and respect. Staff were knowledgeable about the people they cared for, which was commented upon by the people we spoke with. Both people who used the service and their relatives were complimentary about the standard of care received and said they would be happy to recommend the home to others.

We looked at four care files which contained detailed and personalised information about the people who used the service and how they wished to be cared for. Each file contained a range of care plans and risk assessments, which helped ensure people’s needs were being met and their safety maintained. Alongside standardised care plans, individual plans had been implemented to address specific issues.

The home employed an activity coordinator who oversaw all activities and outings facilitated in the home. Everyone we spoke with was positive about the options available and complimentary about the coordinator. We saw a mix of activities were organised throughout the week which catered for all interests and abilities along with regular outings and visits from entertainers. The home had three lounges, which meant that people who did not wish to take part in activities had somewhere they could sit and either read, watch television of chat to others.

The home had a range of systems and procedures in place to monitor the quality and effectiveness of the service. Audits were completed on a weekly, quarterly and annual basis and covered a wide range of areas including medication, care files, nutrition, activities, training, health and safety and the overall provision of care. We saw evidence of action plans being implemented to address any issues found.

Hope Manor is a residential care home located in Salford, Greater Manchester and is owned and operated by Coveleaf Limited. Hope Manor is registered with the Care Quality Commission (CQC) to provide personal care and accommodation for up to 26 people. At the time of our inspection the service had full occupancy.

The home is situated off a busy main road and close to local amenities. Parking facilities are available at the front of the home which also facilitates wheel chair access. Hope Manor is an older building with accommodation that is set over two floors.

We last inspected Hope Manor on 25 and 27 August 2015. During this inspection we found six beaches of the Health and Social Care Act (Regulated Activities) Regulations 2014 in respect of person-centred care, safe care and treatment, meeting nutritional and hydration needs, premises and equipment, good governance and staffing. The service was rated ‘inadequate’ at that time and placed into special measures. We took enforcement action against the provider and four warning notices’ were issued in respect of safe care and treatment, meeting nutritional and hydration needs, good governance and staffing.

Since our last inspection of Hope Manor, CQC had worked with the local authority and NHS community services to monitor improvements at Hope Manor against an action plan submitted by the service. During this inspection, we found significant improvements had been made across all areas of the service. However, we found two continued breaches of the Health and Social Care Act (Regulated Activities) Regulations 2014 in respect of person-centred care and staffing. You can see what action we have taken at the end of this report.

At the time of our inspection there was a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

Since our last inspection, we found that improvements had been made to staffing. For example, a new deputy manager had been recruited, care staff were no longer required to complete laundry duties, and the service had a new activities co-ordinator. However, we found that between the hours of 7.00am and 11.00am there remained insufficient numbers of staff on duty to consistently keep people safe and to ensure people’s needs were met.

We found the service had appropriate systems in place to help protect people from abuse. The service had a safeguarding policy and associated local procedures which were up-to-date. We saw that there were safeguarding posters on display in the office and in the hallway on the notice board. Staff had completed dedicated safeguarding training.

Accidents and incidents were appropriately recorded and included details of preventive strategies used by the service to reduce the likelihood of such events occurring in the future.

Each care file included a Personal Emergency Evacuation Plan (PEEP), which contained information about the level of assistance the person would require in the event of an emergency evacuation.

The service had an appropriate medicines management policy and associated procedures. We found safe procedures for ordering, storage, administration, recording and disposal of medicines. People’s individual Medicine Administration Record (MAR) front sheet contained a photograph and information relating to allergy status.

We looked at recruitment procedures and found robust and safe recruitment practices were in place. This was evidenced through our examination of employment application forms, job descriptions, proof of identity, written references and training certificates. Disclosure and Barring Service (DBS) checks had been undertaken to ensure the applicant’s suitability to work with vulnerable people.

We looked at health and safety and building maintenance records and saw documentation and certificates which demonstrated that relevant checks had been carried out in respect of gas and electrical safety, risks associated with waterborne viruses and hot water temperate checks. Records were also maintained to demonstrate that visual safety checks had been completed for portable electrical appliances. We checked that upper floor windows were compliant with safety regulations and found appropriate window restrictors were in place.

The staff induction programme for new starters was robust and included mandatory training and opportunities for shadowing of more experienced staff. Existing staff were well supported with opportunities for on-going training and professional development.

We looked at the meal time experience and found this to be pleasant and relaxed. Staff assisted people to the tables and explained the food choices to them as they asked for their preferences. Staff chatted with people and were patient whilst people who used the service decided what they wanted to eat and drink. Gentle encouragement was offered to those who required it and assistance given to others.

The Mental Capacity Act 2005 (MCA) provides a legal framework for making particular decisions on behalf of people who may lack the mental capacity to do so for themselves. The Act requires that as far as possible people make their own decisions and are helped to do so when needed. When they lack mental capacity to take particular decisions, any made on their behalf must be in their best interests and as least restrictive as possible.

People can only be deprived of their liberty to receive care and treatment when this is in their best interests and legally authorised under the MCA. The application procedures for this in care homes and hospitals are called the Deprivation of Liberty Safeguards (DoLS). We checked whether the service was working within the principles of the MCA, and whether any conditions on authorisations to deprive a person of their liberty were being met.

There were capacity assessments, which outlined the level of understanding of the individual and where they may require assistance with decision making. There was a DoLS policy in place which included information about restraint and MCA. We saw that DoLS authorisation paperwork was kept in the files, with conditions outlined.

Hope Manor was involved in the ‘Six Steps’ End of Life Care Programme. This is the North West End of Life Programme for Care Homes and is co-ordinated by local NHS services. This means that for people who are nearing the end of their life, they can remain at the home to be cared for in familiar surroundings by people they know and could trust.

Since our last inspection, we found that a significant amount of work had been completed to improve people’s care and support plans. However, we did not see a great deal of evidence in people’s care files to demonstrate how people who used the service, and their relatives or lawful representatives, were involved in reviews and changes to care. We also found that where people who used the service were living with a sensory impairment, the service had not fully considered their individual needs.

The service had recently redeployed an existing member of staff into the role of activities co-ordinator. People we spoke with told us this new role had been very positive and a welcome introduction.

We found positive changes had been made to the operational management of Hope Manor. A new deputy manager had been employed by the service and we saw what a positive contribution they had made alongside the registered manager. We also saw how senior care assistants were now making a positive contribution to the day-to-day operation of the service through effective direction and supervision of staff.

During our visit we spoke to seven people who used the service, six relatives and friends and six members of staff.

Our inspection team was made up of an inspector who addressed our five standard questions; Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, their relatives, the staff supporting them and from looking at records.

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

We found people were treated with respect and dignity by the staff. People told us they felt safe. One person who used the service told us; 'I really like all the staff here and feel very safe and protected.'

We saw safeguarding procedures were robust and staff demonstrated a good understanding of what action to take if they had any concerns.

Systems were in place to make sure that the service and staff learnt from events such as accidents and incidents, complaints, concerns, whistleblowing and investigations. This reduced the risks to people and helped the service to continually improve.

The home had policies and procedures in relation to the Mental Capacity Act and Deprivation of Liberty Safeguards. The manager was able to demonstrate a good understanding of the legislation and had been involved in the submission of applications. Staff had a limited understanding of the legislation and no recent training had been undertaken.

We found the service was clean and hygienic. Equipment was well maintained and serviced regularly therefore people were not put at any unnecessary risk.

The registered manager set the staff rotas and ensured suitable numbers of trained staff were available to meet the needs of people who used the service.

Recruitment practice was safe and thorough.

Policies and procedures were in place to make sure that unsafe practice was identified and people were protected.

Is the service effective?

We found people's health and care needs were assessed with them, and that they or their representatives had been involved in determining what care and support was needed.

Specialist dietary, mobility and equipment needs had been identified in care plans where required.

Visitors confirmed that they were always made to feel welcome and that visiting times were flexible.

Is the service caring?

People were supported by kind and attentive staff. We observed care staff supporting people in a kind and caring manner. People commented; 'It's lovely, we are very happy here.' 'Staff are very kind and always ask if I'm alright.' 'Staff very nice look after us well.' 'They are very good.' 'The care is good here.'

People who used the service, their relatives and friends completed a satisfaction survey.

People's preferences, interests, aspirations and diverse needs had been recorded and care and had been provided in accordance with people's wishes.

Is the service responsive?

There was a limited range of activities available at the home. We were told that these were currently being reviewed by the new manager.

People knew how to make a complaint if they were unhappy. The service had procedures in place to deal with complaints.

Is the service well-led?

The service worked well with other agencies and services to make sure people received their care in a joined up way.

The service had a quality assurance system, records seen by us showed that identified shortfalls were addressed promptly. As a result the quality of the service continuingly improved.

Staff told us they were clear about their roles and responsibilities within the home.

A number of audits were routinely undertaken by the manager.

A questionnaire had been completed by people who used the service or their relatives. Comments were generally very positive and included; 'My X seems happy at this home', 'Clean, helpful and care for my X's needs' and 'I don't think it could be much better than it is.'

The provider and manager had reviewed the record keeping system. We found at this inspection that record keeping had improved.

A relative told us; "My X has put on weight since arriving here, she really loves the place. You can see how she is and that she loves it here. If we take her out she can't wait to get back".

All medicines were appropriately managed and records indicated people who used the service were having their medicines given to them correctly.

We were not provided with any evidence that audit tools had been developed to ensure that the quality of service provision was being effectively monitored. There was no effective system of assessing and monitoring the quality of care plans by the provider.

We spoke with one relative who said "I'm aware of the complaints policy, if I have any concerns I would approach the manager. I know matters will be resolved".

We found that care files were not accurate or updated to reflect changes in dependency and care needs.

During the inspection we spoke with four people who used the service. One person who used the service told us 'I enjoy spending time in my room and the staff respect that'. Another person who used the service told us 'It's like home from home, I'm well looked after here'.

We spoke with three staff members during the inspection who provided us with an overview of their job role. Comments included 'I feel really well supported in my role' and 'I received an induction when I first started here', 'We were supervised for several days before we got into the role properly".

People who used the service spoke highly about the activities and outings which were organised by the home and told us that they happened on a regular basis. One person who used the service told us 'I'm off to the local school this afternoon for a Christmas lunch and I'm looking forward to it'.